Best Exercises for Chronic Low Back Pain (Part 2)

 

 

Last month, we reviewed studies that compared chronic low back pain (cLBP) exercisers to non-exercise control groups and examined how those in the exercise groups experienced significant improvements in pain and disability/function compared with those who remained inactive, regardless of the type of exercise. We also reviewed a few popular Swiss or gym ball exercises. This month, we will introduce some core stabilizing exercises that can be done on the floor.

There are benefits to Swiss ball exercises like balance or proprioception stimulation. In fact, five minutes of ball exercises equals 35 minutes of floor exercising when focusing on balance or proprioception. It is a well-known fact that as we age, we lose our “kinesthetic sense”, or balance skills, so incorporating balance into any exercise program is a good idea!

However, the “con” of Swiss ball exercises is convenience, as such a piece of equipment is less portable. We cannot easily travel with a gym ball, but we all have access to the floor regardless of our location. Also, with exercises performed on the floor, you can achieve stronger muscle contractions due to greater stability. Ideally, MIX the two together! Also, include a 20-30 minute brisk walk for aerobic benefits!   Here are some great floor core stabilization exercises (try holding for 5-10 seconds, repeating 5-10 times, whatever is tolerated):

1)  Pelvic tilts – First, with the knees bent about 90° with your feet on the floor, flatten your low back against the floor by rocking your pelvis back.

2)  Dead Bug – On your back with hips and knees both bent 90° (like sitting in a chair on your back), straighten out the right arm and left leg simultaneously and alternate sides SLOWLY.

3)  Superman – Lay on your stomach with your arm and legs stretched our (like “Superman” flying). Raise one arm and the opposite leg (i.e. right arm/ left leg) and slowly alternate between the other opposing pair. Make it harder by raising BOTH arms and legs at the same time! NOTE:  A pillow under the waist helps.

4)  Bridge – Lay on your back with your knees bent. Lift the buttocks off the ground and push your heels into the floor. Do one leg at a time to make it more challenging.

5)  Sit-ups – There are three leg positions to make it progressively harder (knees bent/feet flat on floor, knees & hips both bent 90°, etc.). Lift your breast bone towards the ceiling and alternate between coming straight up and left and right trunk twists.

6)  Side Bridge (Plank) – If no shoulder problems exist, lay sideways propped up on an elbow and lift the hips off the floor to a straight body position.

7)  Standing squats – Try a quarter, half, or full squat (knee pain dependant) with or without hand weights and with or without a ball squeezed between the knees. Lunges can be substituted or added, if desired.

8)  4-point Quadruped – Kneeling on all fours, straighten out the right arm / left leg and alternate. At the same time, suck in your belly (“abdominal hollowing”) to facilitate the deep transverse abdominis and multifidus muscles. Add a dynamic component by rotating the trunk and approximating your hand to the floor / opposite leg up in the air keeping the body in a straight line.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for any reason, we would be honored to render our services.

 

Best Exercises for Chronic Low Back Pain (Part 1)

Based on simple statistics, we’ve ALL had (or at least will have) some form of low back pain (LBP) at some point in our lives. The term “chronic” applies to LBP that’s been present for at least three months. It has been consistently reported that LBP becomes increasingly difficult to resolve when it persists for three or more months. This month’s topic is about which exercises have been found to BEST address chronic low back pain (cLBP).

Many studies have investigated the effects of stabilization exercises in patients with chronic low back pain. In a review of six recently published studies that followed patients over a four to sixteen week time frame, investigators noted that participants who engaged in exercise (the use of a Swiss ball, floor or “land-based” exercises, sling exercises with some focusing on the abdominal muscles while others looked the extensors) reported improvements in pain and disability that were not seen among those in the non-exercise control groups. Additionally, one study also looked at changes in bone density between both groups and found increased bone density in the exercise group and a reduction in bone density among participants who refrained from exercise. Another study reported waist isometric strength increases in their exercise group.

One study found the cross section of the multifidus (MF) muscles—the deep low back, fine motor muscle groups that is considered to be one of the most important targets for low back strengthening—significantly increased after eight weeks of exercise. Another study observed the same effect for the deep transverse abdominis muscles.

These and other studies clearly show that core stabilization exercises can improve pain and disability scores in patients with cLBP, while those who do not exercise do not improve and in fact, may actually worsen! So, what are core stabilization exercises?

Here are some Swiss ball options (try 5-10 times and increase reps/hold times as you improve your strength):

1) Sitting pelvic tilts – This can be done with both feet (or eventually one foot when you’re ready for an added challenge) on the floor while rocking the pelvis front to back, left to right, or in a circular or “figure-8” manner.

2) Bridge – Start sitting and then walk out so the ball is between the shoulder blades. Keep your trunk parallel to the floor. Push your heels into the floor to activate the hip extensors (buttock muscles) and then walk back up to a sitting position. You can further challenge your balance and hip extensor strength by raising one leg.

3) Sit-ups – Start sitting and roll halfway back and hold it for different lengths of time.

4) See-Saw – Hug the ball and roll out into a push up position. Position the ball under your
pelvis and lift one leg at a time towards the ceiling. Alternate between the left and right legs. You can do BOTH legs together once you get used to this to make it more challenging.

There are MANY other Swiss ball exercises, but these are some good ones to start with. Next month, we’ll look at similar floor or land-based pelvic stabilization exercises!

Whiplash: What’s the “Best Evidence” These Days?

Whiplash, or WAD (Whiplash Associated Disorders), refers to a neck injury where the normal range of motion is exceeded, resulting in injury to the soft-tissues (hopefully with no fractures) in the cervical region. There are a LOT of factors involved that enter into the degree of injury and length of healing time. Let’s take a closer look!

Picture the classic rear-end collision. The incident itself may be over within 300 milliseconds (msec), which is why it’s virtually impossible to brace yourself effectively for the crash as a typical voluntary muscle contraction takes two to three times longer (800-1000 msec) to accomplish.

In the first 50 msec, the force of the rear-end collision pushes the vehicle (and the torso of the body) forwards leaving the head behind so the cervical spine straightens out from its normal “C-shape” (or lordosis). By 75-100 msec, the lower part of the neck extends or becomes more C-shaped while the upper half flexes or moves in an opposite direction creating an “S” shape to the neck. Between 150-200msec, the whole neck hyper extends and the head may hit the head rest IF the headrest is positioned properly. In the last 200-300 msec, the head is propelled forwards into flexion in a “crack the whip” type of motion.

Injury to the neck may occur at various stages of this very fast process, and many factors determine the degree of injury such as a smaller car being hit by a larger car, the impact direction, the position of the head upon impact (worse if turned), if the neck is tall and slender vs. short and muscular, the angle and “springiness” of the seat back and relative position of the headrest, dry vs. wet/slippery pavement, and airbag deployment, just to name a few.

Some other factors that can predict recovery include: limited neck motion, the presence of neurological loss (nerve specific muscle weakness and/or numbness/tingling), high initial pain levels (>5/10 on a 0-10 scale), high disability scores on questionnaires, overly fearful of harming oneself with usual activity and/or work, depressive symptoms, post-traumatic stress, poor coping skills, headaches, back pain, widespread or whole body pain, dizziness, negative expectation of recovery, pending litigation, catastrophizing, age (older is worse), and poor pre-collision health (both mental and physical).

Research shows the best outcomes occur when patients are assured that most people fully recover and when patients stay active and working as much as possible. Studies have shown it’s best to avoid prolonged inactivity and cervical collars unless under a doctor’s orders. It’s also a good idea to gradually introduce exercises aimed at improving range of motion, postural endurance, and motor control provided doing so keeps the patient within reasonable pain boundaries. Chiropractic manipulation restores movement in fixed or stuck joints in the back and neck and has been found to help significantly with neck pain and headaches, particularly for patients involved in motor vehicle collisions. A doctor of chiropractic may also recommend using a cervical pillow, home traction, massage, and other therapies as part of the recovery process.

It is important to be aware that fear of normal activity and not engaging in usual activities and work can delay healing and promote chronic problems and long-term disability. It’s suggested patients avoid opioid medication use due to the addictive problems with such drugs. Ice and anti-inflammatory herbs or nutrients (like ginger, turmeric, and bioflavonoids) are safer options. Your doctor of chiropractic can guide you in this process!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

What Is Causing My Back Pain?

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Low back pain (LBP) can arise from disks, nerves, joints, and the surrounding soft tissues. To simplify the task of determining “What is causing my LBP?” the Quebec Task Force recommends that LBP be divided into three main categories: 1) Mechanical LBP; 2) Nerve root related back pain; and 3) Pathology or fracture. We will address the first two, as they are most commonly managed by chiropractors.

Making the proper diagnosis points your doctor in the right direction regarding treatment. It avoids time wasted by treating an unrelated condition, which runs the risk of increased chances of a poor and/or prolonged recovery. Low back pain is no exception! The “correct” diagnosis allows treatment to be focused and specific so that it will yield the best results.

Mechanical low back pain is the most commonly seen type of back pain, and it encompasses pain that arises from sprains, strains, facet and sacroiliac (SI) syndromes, and more. The main difference between this and nerve root-related LBP is the ABSENCE of a pinched nerve. Hence, pain typically does NOT radiate, and if it does, it rarely goes beyond the knee and normally does not cause weakness in the leg.

The mechanism of injury for both types of LBP can occur when a person does too much, maintains an awkward position for too long, or over bends, lifts, and/or twists. However, LBP can also occur “insidiously” or for seemingly no reason at all. However, in most cases, if one thinks hard enough, they can identify an event or a series of “micro-traumas” extending back in time that may be the “cause” of their current low back pain issues.

Nerve root-related LBP is less common but it is often more severe—as the pain associated with a pinched nerve is often very sharp, can radiate down a leg often to the foot, and cause numbness, tingling, and muscle weakness. The location of the weakness depends on which nerve is pinched. Think of the nerve as a wire to a light and the switch of the nerve is located in the back where it exits the spine. When the switch is turned on (the nerve is pinched), and the “light” turns on—possibly in the outer foot, middle foot, inner foot, or front, back or side of the thigh. In fact, there are seven nerves that innervate or “run” into our leg, so usually, a very specific location “lights up” in the limb.

Determining the cause of your low back pain helps your doctor of chiropractic determine which treatments may work best to alleviate your pain as well as where such treatments can be focused.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Causes of Back Pain You Don’t Normally Think About…

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Between 80% and 90% of the general population will experience an episode of lower back pain (LBP) at least once during their lives. When it affects the young to middle-aged, we often use the term “non-specific LBP” to describe the condition. The geriatric population suffers from the “aging effects” of the spine—things like degenerative joint disease, degenerative disk disease, and spinal stenosis. Fractures caused by osteoporosis can also result in back pain.

The “good news” is that there are rare times when your doctor must consider a serious cause of LBP. That’s why he or she will ask about or check the following during your initial consultation: 1) Have you had bowel or bladder control problems? (This is to make sure a patient doesn’t have “cauda equina syndrome”—a very severely pinched nerve.) 2) Take a patient’s temperature and ask about any recent urinary or respiratory tract infections to rule out spinal infections. 3) To rule out cancer, a doctor may ask about a family or personal history of cancer, recent unexplained weight loss, LBP that won’t go away with time, or sleep interruptions that are out of the ordinary. 4) To rule out fractures, a doctor may also take x-rays if a patient is over age 70 regardless of trauma due to osteoporosis, over age 50 with minor trauma, and at any age with major trauma.

Once a doctor of chiropractic can rule out the “dangerous” causes of LBP, the “KEY” form of treatment is giving reassurance that LBP is manageable and advise LBP sufferers of ALL ages (especially the elderly) to KEEP MOVING! Of course, the speed at which we move depends on many things—first is safety, but perhaps more importantly is to NOT BECOME AFRAID to do things! As we age, we gradually fall out of shape and end up blaming our age for the inability to do simple normal activities. Regardless of age, we must GRADUALLY increase our activities to avoid the trap of sedentary habits resulting in deconditioning followed “fear avoidant behavior!”

Here are a few “surprising” reasons your back may be “killing you”: 1) You’re feeling down – That’s right, having “the blues” and more serious mood disorders, like depression, can make it more difficult to cope with pain. Also, depression often reduces the drive to exercise, may disturb sleep, and can affect dietary decisions—all of which are LBP contributors. 2) Your phone – Poor posture caused by holding a phone between your bent head and shoulder (get a headset!) or prolonged mobile phone use can increase your risk for spinal pain. 3) Your feet hurt, which makes you walk with an altered gait pattern, forcing compensatory movements up the “kinetic chain” leading to LBP. 4) Core muscle weakness, especially if you add to that a “pendulous abdomen” from being overweight—this is a recipe for disaster for LBP. 5) Tight short muscles such as hamstrings, hip rotator muscles, and/or tight hip joint capsules are common problems that contribute to LBP. Stretching exercises can REALLY help!

10 Tricks to Manage Low Back Pain

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Low back pain (LBP) is VERY likely to affect all of us at some point in life. The question is, do you control IT or does IT control you? Here are ten “tricks” for staying in control of “IT!”
1) STRETCH: When you’re in one position for a long time (like sitting at your desk), SET your cell phone timer to remind yourself to get moving and stretch every 30-60 minutes! Mornings are a great time to stretch.
2) BE SMART: Do NOT place your computer monitor anywhere other than directly in front of you. Shop carefully for a GOOD supportive office chair that is comfortable and a good fit.
3) POSTURE: For sitting, sit as upright as comfortably possible keeping your chin tucked in so the head stays back over the shoulders.
4) SHOE WEAR: Avoid wearing heels greater than one inch high (2.54 cm). A supportive shoe that can be worn COMFORTABLY for several hours is ideal! Generally, the “skimpier” the shoe, the worse the support, so don’t “skimp” on shoe wear!
5) SMOKING: Carbon monoxide from cigarette smoke competes with oxygen at each cell in the body literally suffocating them, which makes the healing process more difficult.
6) WEIGHT: Your body mass index (BMI) should be between 18.5 and 25. Search the internet for “BMI Calculator” and plug in your height and weight to figure out yours. BMI is a reliable indicator of body fatness and a great way to determine where you are at for goal setting.
7) ANTI-INFLAMMATION: Common over the counter (OTC) medications include ibuprofen and naproxen. However, recent studies show these types of medications (NSAIDS) may delay the healing process. A healthier choice is ginger, turmeric, and bioflavonoids, which are commonly bundled together in a supplement. Eat fresh fruits, veggies, lean meats, and food rich in omega-3 fatty acids. Vitamin D, magnesium, and coenzyme Q10 are also smart choices. AVOID FAST FOOD as they tent to be rich in omega-6 fatty acids, which can promote inflammation.
8) ICE: This could be included in #7 but deserves its own space. Ice reduces swelling while heat promotes it. Try rotations of ice every 15-20 minutes for about an hour three times a day to “pump” out the swelling!
9) STAY ACTIVE: Balance rest with physical activity like exercise or simply going for a walk. The most important thing is to move your body around.
10) STRENGTHEN: Core stabilizing exercises (sit-ups, planks, quadruped) and BALANCE exercises are VERY important!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Whiplash, we would be honored to render our services.

Where Does Back Pain Come From?

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Most of us have suffered from back pain at one time or another. It often occurs after over-doing a physical task, like fall yard work, winter snow shoveling, working on the car, cleaning the house, and so on. But there are times when identifying the cause of back pain can be difficult or impossible. Let’s take a deeper look at where back pain can come from…

Though activity-related back pain is common, many times a direct link to over-use is not clear. Micro-traumatic events can accumulate and become painful when a certain threshold is exceeded. (Think of the old adage “The straw that broke the camel’s back.”)

There are other less well-identified causes of back pain. One is called referred pain. This can be caused by an irritated joint or soft tissue not necessarily located in the immediate area of the perceived pain. For example, pain in the leg can result from an injured facet joint, sacroiliac joint, and/or a disk tear (without nerve root pinch). This is called “sclertogenous pain.”

Internal organs can also cause back pain. This is called a “viscerosomatic response” (VSR). A classic example of this is when the right shoulder blade seems to be the source of pain when the gall bladder is inflamed. This pain can be located at or below the scapula next to the spine and the muscles in the area are in spasm and sensitive or painful to the touch. Also, VSR is often not worsened or changed by bending in different directions (unlike musculoskeletal / MSK pain). Without further testing, it’s easy to confuse this with a MSK or a “typical” back ache. Ultimately, a final diagnosis may require an abdominal ultrasound (CT, MRI scan, and other diagnostics are less frequently used).

Visceral pathology in the back pain patient presenting to chiropractors is reportedly rare, and according to one survey, only 5.3% of patients present with non-musculoskeletal complaints. Other common VSR pain patterns are as follows: Heart – left chest to left arm, mid-upper back, left jaw; Liver – right upper shoulder (front and back), right middle to low back, and just below the sternum; Appendix – right lower abdomen (may start as stomach pain); Small intestine – either side of the umbilicus and/or between it and the breast bone; Kidney – small of the back, upper tailbone, and/or groin area; Bladder – just above the pubic bone and/or bilateral buttocks; Ovaries – groin and/or umbilical area; and Colon – mid-abdominal and/or lower quadrants.

Another challenge to diagnosis is cancer in the spine, which can be primary or metastatic (from a different location). Thankfully, this is very rare. A history of unexplained weight loss, a past history of cancer, over age 50, nighttime sleep interruptions, and no response to usual back care may lead a doctor to recommend tests to determine if cancer is present in the spine.

Bottom line: When patients present with back pain, chiropractors have been trained to look for these less common but important causes of back pain. They get “suspicious” when the “usual” orthopedic tests do not convey the usual responses seen with mechanical back pain. In these cases, they work with primary care doctors to coordinate care to obtain prompt diagnostic testing and treatment.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Whiplash – What Exercises Should I Do? (Part 2)

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Last month, we looked at the VERY important deep neck flexor muscles. As promised, this month, we will cover exercises to work the deep neck extensors.

Since the 1990s, the deep neck flexors have been getting most of the attention as being the “missing link” in rehab of the neck after whiplash. As important as the deep neck flexors are, the deep neck extensors cannot be ignored. In fact, BOTH the deep neck flexors and extensors have to work in concert to control segmental movement! A 2013 study reported the deep neck extensors can become quite de-conditioned and weak in patients with neck pain. Recent studies confirm that neck pain patients typically display reduced activation AND a less defined activation pattern in the deep neck extensors, and the amount of weakness and poor activation is proportional to the amount of pain present (i.e., the higher the pain level, the worse the activity response).

PROCEDURE 3 (Prone Neck Extensors): Lying on your stomach, arms at your sides, palms facing outwards, tuck in the chin without looking down. Lift you head and chest off the floor and hold the position for ten seconds or as long as can be tolerated. Remember, stay within “reasonable boundaries of pain” (that only YOU can define) and gradually add repetitions over time.

PROCEDURE 4 (Neck Extensor Isometrics): Sitting or standing, tuck in your chin without looking down. Extend the head back slightly and place one hand behind the head. Slowly push the head back into your fingers at about 10% of maximum force and gradually use a greater amount of force over time. Once you feel you have good motor control and are tolerating the exercise well, vary the amount of resistance from 10% to 90%, gradually increasing then decreasing the resistance SLOWLY (crescendo and decrescendo the resistance)!

PROCEDURE 5 (Neck Extensor Isotonics): Same as above but this time the head moves while applying a steady light (10-25% of max.) resistance from full extension into full flexion. Repeat this for three to five slow repetitions through the full range. Keep your chin tucked while moving the head into your hand. The object is to SMOOTHLY move your head into and out of flexion/extension SLOWLY through as much of the range as possible (remember you define the pain boundaries)!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Whiplash, we would be honored to render our services.

Whiplash – What Exercises Should I Do? (Part 1)

Whiplash exercise

Whiplash, or “Whiplash Associated Disorders” (WAD), results from a sudden jarring motion, often from a car crash that occurs too fast for someone to voluntarily “brace” themselves. This is because the whole “whiplash cycle” is over within 300msec, and we cannot contract a muscle faster than 700-800 msec. Other injury factors include: the type and angle of the crash, the size of the involved vehicles, the speed, the absorption of the crash by crushing metal (or lack thereof), the size of the person (and gender), angle of the seat back and it’s “stiffness,” the position of the head rest, and the slipperiness of the road. ALL these factors (and more) help determine whether an injury occurs as well as the degree of injury!

There is so much published about neck pain resulting from whiplash that it’s confusing (to say the least) about which exercises are best for the whiplash patient. Rather, each patient needs to be assessed and managed based on their unique situation.

In regards to neck pain, an exercise program must have three goals: Stretching, Strengthening, and Stabilizing. All three goals work towards a common purpose: To restore function. Initially, when pain factors are high, patients perform active movement within reasonable pain boundaries to improve their cervical range of motion. Once movement is fairly well tolerated, it’s time to focus on strengthening exercises.

There are certain muscles that can “hide” behind larger, stronger muscles and are more difficult to isolate, and therefore, very often remain weak — even sometimes in spite of strengthening exercises. One VERY important muscle group is called the deep neck flexors, which “hide behind” the stronger, more superficial neck flexing muscle called the sternocleidomastoid (SCM). To “trick” the SCM into NOT contracting (so we can engage and exercise the deep neck flexors), we drop the chin to the chest without flexing the head forwards (like the downward motion when nodding “yes”). Try it! You should feel “the pull” or a stretch in the muscles in the back of your neck. This is referred to as “craniocervical flexion” but we’ll call it a “chin tuck.”

PROCEDURE 1: Perform the above “chin tuck” by lying on your back, chin tuck, and press your neck down into the bench or floor, hold for three-to-five seconds and then release the chin tuck SLOWLY (two times slower than the initial downward movement). If you can’t get your neck to flatten out, repeat this with a small rolled up towel placed behind the neck. Start with three-to-five repetitions and gradually increase the reps and sets. To make this more “portable” so you can do this during the day, see Procedure 2.

PROCEDURE 2: In a seated or standing position, place your finger tips behind your neck and push your neck into your fingers gradually increasing the pressure as you apply the “chin tuck.” Do this slowly, applying gradual pressure INTO your finger tips and then (MOST IMPORTANTLY), release the pressure SLOWLY (again, two times slower than the initial “push”). Repeat three-to-five times for one session and do multiple sessions during the day. SET THE TIMER on your cell phone for two or three hrs to REMIND you to do these multiple times a day!

Next month, we will address the deep neck extensors, as well as other deep muscles!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Whiplash, we would be honored to render our services.

Truths & Myths of MRI for Low Back Pain

Low back pain is a very common complaint. In fact, it’s the #1 reason for doctor visits in the United States! The economic burden of LBP on the working class is astronomical. Most people can’t afford to be off work for one day, much less a week, month, or more! Because of the popularity of hospital-based TV dramas over the past two decades, many people think getting an MRI of their back can help their doctor fix their lower back problem. Is this a good idea? Let’s take a look!

Patients will often bring in a CD that has an MRI of their lower back to a doctor of chiropractic and ask the ultimate question, “….can you fix me?” Or, worse, “…I think I need surgery.” Sure, it’s quite amazing how an MRI can “slice” through the spine and show bone, soft tissues, disks, muscles, nerves, the spinal cord, and more! Since the low back bears approximately 2/3 of our body’s weight, you can frequently find MANY ABNORMALITIES in a person over 40-50 years old. In fact, it would be quite odd NOT to see things like disk degeneration, disk bulges, joint arthritis, spur formation, etc.!

Hence, the “downside” of having ALL this information is the struggle to determine which finding on the MRI has clinical significance. In other words, where is the LBP coming from? Is it that degenerative disk, bulged disk, herniated disk, or the narrowed canal where the nerve travels? Interestingly, in a recent review of more than 3,200 cases of acute low back pain, those who had an MRI scan performed earlier in their care had a WORSE outcome, more surgery, and higher costs compared with those who didn’t succumb to the temptation of requesting an MRI!

This is not to say MRI, CT scans, and x-rays are not important, as they effectively show conditions like subtle fractures and dangerous conditions like cancer. But for LBP, MRI is often misleading. This is because the primary cause of LBP is “functional” NOT “structural,” so it’s EASY to get railroaded into thinking whatever shows up on that MRI has to be the problem.

Here is how we know this, when we take 1,000 people WITHOUT low back pain between ages 30 and 60 (male or female) and perform an MRI on their lower back, we will find up to 53% will have PAINLESS disk bulges in one or more lumbar disks. Moreover, we will find up to 30% will have partial disk herniations, and up to 18% will have an extruded disk (one that has herniated ALL the way out). Yet, these people are PAIN FREE and never knew they had disk “derangement” (since they have no LBP). When combining all of these possible disk problems together, several studies report that between 57% and 64% of the general population has some type of disk problem without ANY BACK PAIN!

Hence, when a patient with a simple sprain/strain and localized LBP presents with an MRI showing a disk problem, it usually ONLY CONFUSES the patient (and frequently the doctor), as that disk problem is usually not the problem causing the pain!  So DON’T have an MRI UNLESS a surgical treatment decision depends on its findings. That is weakness, numbness, and non-resolving LBP in spite of 4-6 weeks of non-surgical care or unless there is weakness in bowel or bladder control. Remember, the majority of back pain sufferers DO NOT need surgery!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

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